%0 Generic
%A C., Wohlmuth
%A E., Bergh
%A C., Bell
%A A., Johnson
%A K.J., MoiseJr.
%A M.J.C., vanGemert
%A J.P.H.M., vandenWijngaard
%A I., Wohlmuth-Wieser
%A I., Averiss
%A H.M., Gardiner
%D 2019
%T Supplementary Material for: Clinical Monitoring of Sacrococcygeal Teratoma
%U https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Clinical_Monitoring_of_Sacrococcygeal_Teratoma/7868261
%R 10.6084/m9.figshare.7868261.v1
%2 https://karger.figshare.com/ndownloader/files/14652218
%K Sacrococcygeal teratoma
%K Fetal surgery
%K Cardiovascular pathophysiology
%K Vascularization index
%K Umbilical/venous diameter ratio
%K Hydrops
%X Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9–11.6] vs. 4.4 [3.4–5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.
%I Karger Publishers